Every osteopath has their own treatment style, some prefer using gentle articulations to stretch muscles and mobilise joints, others prefer using manipulations to release joints. Personally I utilise both as well as medical acupuncture and sports taping to relax muscles and support the area.

Today I want to talk you through a typical treatment with Wokingham Osteopaths, along with the thinking that follows. I’m going to use myself as a patient, as it is difficult to gain consent for taking photos with existing patients and provide an effective treatment at the same time.

On an early April Thursday afternoon, midway through treating a full roster of patients I realised that my right shoulder was painful when I lifted it up.

Symptoms:

• There was no particular cause, it came on idiopathically.
• The pain occurred when bringing my arm away from my side between 60′ and 120′ up to the ceiling. No pain was produced on neck movement.
• No visible inflammation.
• Soreness upon palpation (touching) of the top of my shoulder blade.
• No neurological symptoms into my hands (numbness, weakness, shooting pain, pins and needles), this means that the nerves in the arm are not likely to be involved.
• There was no discolouration or markings signifying trauma to the area.

First, was it ligament damage? Unlikely as I hadn’t suffered any trauma like a fall or car crash that could have sprained or torn a ligament.

Secondly, was it a fracture? Equally unlikely; I hadn’t fallen over, nor did I have any form of bone-weakening condition such as osteoporosis that would leave me vulnerable to fractures from smaller impacts. If I was in a high-risk category I may have regarded a fracture as being more likely, even without trauma.

Thirdly, was it a muscle strain or inflammation? The pain was present with muscular contraction because I felt it when I moved the area. I picked up the right arm with the left arm, so the muscles weren’t contracting, and the pain did not reproduce.

This led me to believe that the pain was caused by a muscle, but which? Given the movement hurt on raising the arm laterally (away to the side) it could be one of two muscles, the medial deltoid or the supraspinatus.

The supraspinatus is responsible for assisting the deltoid with lateral flexion between 60’ and 120’, which was the region I was experiencing pain, so this seemed to be the muscle most likely to be giving me problems. To confirm my diagnosis I performed several clinical tests which test for supraspinatus tendonitis, all of which were positive.

I have had similar issues in the past and when a musculoskeletal issues happens once it is likely to happen again, especially if the underlying issues are not addressed. Osteopathy is a very physical job so I clearly need to pay attention to my shoulder.  This lends credence to the diagnosis of a supraspinatus muscle issues and is why it is so important to take a case history of a patient at the beginning of an initial consultation.

The most likely cause is inflammation of the tendon of the supraspinatus muscle. My treatment plan was to relax the tight muscle and reduce inflammation.

Massage and medical acupuncture, or dry needling, would reduce the tension on the tendon, with sports tape helping the support the area post-treatment.

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I performed gentle massage into the supraspinatus muscle to start relaxing it off, then performed medical acupuncture.

Medical Acupuncture is thought to work by encouraging the release of endorphins to act as a pain reliever and muscle relaxant.

I haven’t had medical acupuncture for any musculoskeletal conditions before this, only as part of our training and was pleasantly surprised at how quickly it made a difference.

After the acupuncture I got on with the sports taping, which helps to reduce inflammation in the area underneath the tape, as well as support the area after treatment.

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Within 10 minutes of having started treatment I was able to lift my arm in a nearly pain-free manner. The last time I suffered with this the symptoms took three days to ease off as I was only able to use massage, so to have such instantaneous relief was quite a thing.

If neurological symptoms were present, or there was pain on neck movement I would have examined my neck and felt for any tight muscles or joint restrictions. If any were found, a treatment plan involving gentle joint articulation and massage into the neck muscles may have been more beneficial.

One of the maintaining factors may have been that I carry a very heavy treatment couch in and out of patients houses 3 days a week as part of Visiting Osteopaths. In order to reduce the likelihood of recurrence my goal is to either alternate the shoulder with which I carry my couch, or get a trolley to reduce the strain on the right shoulder. Self-massage is always a useful tool to prevent a musculoskeletal disorder from recurring

If you have any questions or wish to make a booking call us on 0118 380 0385 or fill out the contact form in the sidebar.

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After our last blog post announcing Keri’s pregnancy I have had several patients asking how pregnancy causes lower back pain. As a result I thought I would write a post explaining why back pain can occur.

For many women, as their pregnancy unfolds they may notice new symptoms in the lower back, like a niggling sensation, pain on performing certain movements like rolling over in bed and stiffness when standing straight.

There are plenty of reasons for this, including but not limited to; Relaxin release, disc issues and increased muscular tension. We’re going to focus on the latter, caused by the shift of the centre of gravity. The muscles of the spinal column are there to keep you upright and they are very good at it. As the foetus grows, your centre of gravity shifts forward and the lower back muscles compensate for this by contracting more to bring you upright. A similar mechanism happens when you wear high heels, the pelvis is pushed forward so the body compensates by arching your back.

This image may be about wearing high heels but the effect is the same. The pelvis tips forward and the lumbar curve is increased, placing pressure on the nerves in the lower back.

Sometimes, depending on your height, activity levels and occupation, the muscles can contract too much, causing a dull ache on one or both sides of the lower back. If you experience sharp pain, it may be because the tight muscles have brought the vertebrae too close together and they have compressed a nerve. This can cause pain in the local area as well as the areas that the nerve supplies. A good example of this is Sciatica, whereby the Sciatic nerve is compressed which causes pain down into the back of the legs, sometimes as far as the toes.

Image courtesy of Physiopedia.

What can you do about it?

There are several options for self-care, including massage, stretches (within reason) and seeing an osteopath.

Self massage can be as simple as sitting on a squash ball, not with your full weight if painful, and placing pressure on tender points in the gluteal muscles. If your partner is happy to do so, they can also work through the muscles. I write this after having just worked on Keri’s glutes as she was having sharp pain in her lower back when rolling over in bed. After establishing that the gluteal muscles were the problem, I placed firm pressure with the heels of my hands until it became uncomfortable and held until the discomfort faded. Post massage there was still a slight niggle, but the act of rolling over was so much easier for her.

Stretches like the knee hug and gluteal stretches can be very useful for stretching the tight muscles, especially coupled with massage work. However, the suitability of these stretches depend upon your stage of pregnancy so speak with a manual therapist (osteopath, physiotherapist etc) to discuss them.

Osteopathic treatment utilises massage, stretches and articulations to release tight muscles that may be placing pressure on the nerves in the lower back. To enquire about how it might help you please call 0118 380 0385.

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Hello and welcome to the Wokingham Osteopaths blog. My name is Keri and I’m Matt’s partner and also an Osteopath, no prizes for guessing how we met! As some of Matt’s existing patients will know, I am 16 weeks pregnant and expecting our first baby in May next year.

Most of the patients I treat are young babies and as such I wanted to document and share with you the changes happening to a woman’s body throughout this exciting time. To do this I will be offering advice and tips about how you might be able to look after your body and what to do if you run into the same difficulties as me.

The first 12 weeks of any pregnancy are always nerve wracking! At this point there are no physical signs (on the outside at least) that you are pregnant at all! Personally I experienced very few “typical” pregnancy symptoms; I had no morning sickness and only very mild and occasional nausea.

I found that during these early weeks I had some intermittent pelvic pain at the end of a long day of treating my own patients courtesy of the peaking levels of Relaxin in my system. Relaxin will soften your ligaments, allowing your body to grow and change shape throughout your pregnancy.

Now at 16 weeks my little bump is becoming more obvious and it’s time to move to either elasticated or maternity trousers and jeans. I’m at that awkward point in pregnancy where people can’t quite tell if I’m pregnant or just had a really big meal, most will be too polite to ask!

If you do experience some back or pelvic pain like me, gentle yoga stretches or even joining a pregnancy yoga class if you have the time is usually a good idea. Alternatively, warm compresses to the lower back can also be helpful. Soaking in hot baths for hours is no longer advisable as it can be dangerous for the baby to be submerged in hot water for too long. Getting your partner to do some gentle massage to your lower back may also help.

For more advice or safe and effective Osteopathic treatment during your pregnancy, contact Matt or Keri at Wokingham Osteopaths on 0118 380 0385.

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